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3. Cost-effectiveness of pharmacogenomic-guided treatment for major depression

Author

Ghanbarian, Shahzad, Wong, Gavin W.K., Bunka, Mary, Edwards, Louisa, Cressman, Sonya, Conte, Tania, Price, Morgan, Schuetz, Christian, Riches, Linda, Landry, Ginny, Erickson, David, McGrail, Kim, Peterson, Sandra, Vijh, Rohit, Hoens, Alison M., Austin, Jehannine, and Bryan, Stirling

Subjects
Economic aspects, Analysis, Health care costs -- Economic aspects -- Analysis, Evidence-based medicine -- Economic aspects -- Analysis, Antidepressants -- Analysis -- Economic aspects, Major depressive disorder -- Economic aspects -- Analysis, Medical research -- Analysis -- Economic aspects, Pharmacogenomics -- Analysis -- Economic aspects, Medicine, Experimental -- Analysis -- Economic aspects, Medical care, Cost of -- Economic aspects -- Analysis, Pharmacogenetics -- Analysis -- Economic aspects
Abstract

Pharmacogenomic testing offers the possibility of enhanced efficacy and fewer adverse effects from more appropriately targeted drug therapies. One clinical area for which pharmacogenomics could have particular promise is major [...], Background: Pharmacogenomic testing to identify variations in genes that influence metabolism of antidepressant medications can enhance efficacy and reduce adverse effects of pharmacotherapy for major depressive disorder. We sought to establish the cost-effectiveness of implementing pharmacogenomic testing to guide prescription of antidepressants. Methods: We developed a discrete-time microsimulation model of care pathways for major depressive disorder in British Columbia, Canada, to evaluate the effectiveness and cost-effectiveness of pharmacogenomic testing from the public payer's perspective over 20 years. The model included unique patient characteristics (e.g., metabolizer phenotypes) and used estimates derived from systematic reviews, analyses of administrative data (2015-2020) and expert judgment. We estimated incremental costs, life-years and quality-adjusted life-years (QALYs) for a representative cohort of patients with major depressive disorder in BC. Results: Pharmacogenomic testing, if implemented in BC for adult patients with moderate-severe major depressive disorder, was predicted to save the health system $956 million ($4926 per patient) and bring health gains of 0.064 life-years and 0.381 QALYs per patient (12 436 life-years and 74 023 QALYs overall over 20 yr). These savings were mainly driven by slowing or avoiding the transition to refractory (treatment-resistant) depression. Pharmacogenomic-guided care was associated with 37% fewer patients with refractory depression over 20 years. Sensitivity analyses estimated that costs of pharmacogenomic testing would be offset within about 2 years of implementation. Interpretation: Pharmacogenomic testing to guide antidepressant use was estimated to yield population health gains while substantially reducing health system costs. These findings suggest that pharmacogenomic testing offers health systems an opportunity for a major value-promoting investment.

Published
2023
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4. Changes over time in patient visits and continuity of care among graduating cohorts of family physicians in 4 Canadian provinces

Author

Rudoler, David, Peterson, Sandra, Stock, David, Taylor, Carole, Wilton, Drew, Blackie, Doug, Burge, Fred, Glazier, Richard H., Goldsmith, Laurie, Grudniewicz, Agnes, Hedden, Lindsay, Jamieson, Margaret, Katz, Alan, MacKenzie, Adrian, Marshall, Emily, McCracken, Rita, McGrail, Kim, Scott, Ian, Wong, Sabrina T., and Lavergne, M. Ruth

Subjects
Practice, Statistics, General practitioners -- Statistics -- Practice, Family medicine -- Statistics, Continuum of care -- Statistics, Medical care utilization -- Statistics, Health care services accessibility -- Statistics, Medical care -- Utilization, Physicians (General practice) -- Statistics -- Practice
Abstract

Access to primary care services in Canada falls short of comparable countries. (1) Despite increasing absolute numbers of family physicians, (2) evidence suggests that the volume of patient contacts and [...], Background: Lack of patient access to family physicians in Canada is a concern. The role of recent physician graduates in this problem of supply of primary care services has not been established. We sought to establish whether career stage or graduation cohort were related to family physician practice volume and continuity of care over time. Methods: We conducted a retrospective cohort study of family physician practice from 1997/98 to 2017/18. We collected administrative health and physician claims data in British Columbia, Manitoba, Ontario and Nova Scotia. We included all physicians who registered with their respective provincial regulatory colleges as having a medical specialty of family practice or who had billed the provincial health insurance system for patient care as family physicians, or both. We used regression models to isolate the effects of 3-year categories of years in practice (at all career stages), time period and cohort on patient contacts and physician-level continuity of care. Results: Between 1997/98 and 2017/18, the median number of patient contacts per provider per year fell by between 515 and 1736 contacts in the 4 provinces examined. Median contacts peaked at 27-29 years in practice in all provinces, and median physician-level continuity of care increased until 30 or more years in practice. We found no association between graduation cohort and patient contacts or physician-level continuity of care. Interpretation: Recent cohorts of family physicians practise similarly to their predecessors in terms of practice volumes and continuity of care. Because family physicians of all career stages showed declining patient contacts, we suggest that system-wide solutions to recent challenges in the accessibility of primary care in Canada are needed.

Published
2022
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9. Caregiver Involvement and Concerns with Care of Residents of Assisted Living Before and During the COVID-19 Pandemic

Author

Hoben, Matthias, primary, Li, Wenshan, additional, Dampf, Hana, additional, Hogan, David B., additional, Corbett, Kyle, additional, Chamberlain, Stephanie A., additional, McGrail, Kim, additional, Griffith, Lauren E., additional, Gruneir, Andrea, additional, Lane, Natasha E., additional, Baumbusch, Jennifer, additional, and Maxwell, Colleen, additional

Published
2023
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10. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID‐19 pandemic.

Author

Hoben, Matthias, Hogan, David B., Poss, Jeffrey W., Gruneir, Andrea, McGrail, Kim, Griffith, Lauren E., Chamberlain, Stephanie A., Estabrooks, Carole A., and Maxwell, Colleen J.

Subjects
MEDICAL quality control, EVALUATION of medical care, KEY performance indicators (Management), CONFIDENCE intervals, PAIN, CROSS-sectional method, CONGREGATE housing, NURSING care facilities, RISK assessment, COMPARATIVE studies, CLINICAL medicine, RESEARCH funding, MENTAL depression, COVID-19 pandemic, ANTIPSYCHOTIC agents
Abstract

Background: While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID‐19 pandemic. Our study compared trends of practice‐sensitive, risk‐adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. Methods: This repeated cross‐sectional study used population‐based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017–12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk‐adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late‐loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. Results: Quarterly samples included 2015–2710 AL residents and 12,881–13,807 NH residents. Antipsychotic use (21%–26%), pain (20%–24%), and depressive symptoms (17%–25%) were most common in AL. In NHs, they were physical dependency (33%–36%), depressive symptoms (26%–32%), and antipsychotic use (17%–22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%–1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%–0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%–0.8%], p = 0.0222). Conclusions: QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact. [ABSTRACT FROM AUTHOR]

Published
2023
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14. Patient characteristics associated with enrolment under voluntary programs implemented within fee-for-service systems in British Columbia and Quebec: a cross-sectional study

Author

Lavergne, M. Ruth, primary, King, Caroline, additional, Peterson, Sandra, additional, Simon, Leora, additional, Hudon, Catherine, additional, Loignon, Christine, additional, McCracken, Rita K., additional, Brackett, Austyn, additional, McGrail, Kim, additional, and Strumpf, Erin, additional

Published
2022
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15. Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces’ Administrative Health Care Data Evaluating Changes over Time

Author

Khan, Amanda Farah, primary, Seow, Hsien, additional, Sutradhar, Rinku, additional, Peacock, Stuart, additional, Chan, Kelvin Kar-Wing, additional, Burge, Fred, additional, McGrail, Kim, additional, Raymakers, Adam, additional, Lawson, Beverley, additional, and Barbera, Lisa, additional

Published
2021
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18. The Association Between Varying Levels of Palliative Care Involvement on Costs During Terminal Hospitalizations in Canada from 2012–2015 (F405C)

Author

Isenberg, Sarina R., primary, Meaney, Chris, additional, May, Peter, additional, Tanuseputro, Peter, additional, Quinn, Kieran L., additional, Qureshi, Danial, additional, Saunders, Stephanie, additional, Webber, Colleen, additional, Seow, Hsien, additional, Downar, James, additional, Smith, Thomas J., additional, Lawlor, Peter G., additional, Lachance, Julie, additional, McGrail, Kim, additional, and Hsu, Amy T., additional

Published
2021
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20. Why are babies in Canada getting smaller?

Author

El Adam, Shiraz, Hutcheon, Jennifer A., McLeod, Chris, and McGrail, Kim

Subjects
BIRTH weight, GESTATIONAL age, OLDER women, SOCIODEMOGRAPHIC factors, BIRTHPARENTS
Abstract

Introduction Recent evidence from the United States and Canada suggests an unexplained increase in small-for-gestational-age (SGA) births (<10th percentile). This study aimed to identify reasons for the recent increase in SGA births in Canada. Data and methods Using Canada's Vital Statistics - Birth Database, the study population included all singleton live births, 2000 to 2016, inclusive. Temporal changes in birth weight (grams), birth weight for gestational age z-scores, and SGA births were examined. Multivariable logistic regression was used to determine if the increased risk of an SGA birth over time was eliminated or attenuated by adjusting for selected individual and sociodemographic factors that have previously been associated with SGA births. Results There were 5,941,820 singleton live births in Canada between 2000 and 2016. Mean birth weight for all births decreased from 3,442 grams in 2000, to 3,367 grams in 2016, while SGA birth increased from 7.2% in 2000 to 8.0% in 2016. The multivariable model showed higher odds of SGA birth among births to parents born outside of Canada, unmarried women, older women, nulliparous women and women residing in low income neighborhoods. After adjusting for sociodemographic factors, the crude 12% increase in odds of SGA birth in 2016 compared to 2000 (95% Confidence Interval (CI): [10 to 14%]) was attenuated, but not eliminated (adjusted odds ratio for calendar time 1.08 (95% CI: [1.06, 1.10])). Interpretation This study identified a decrease in fetal size in Canada between 2000 and 2016. The rise in SGA births in Canada was explained only partly as a result of concurrent changes in the demography of childbirth. [ABSTRACT FROM AUTHOR]

Published
2022
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28. The BC SUPPORT Unit Data Platform: Offering Data-Related Services To Researchers In British Columbia

Author

Kesselring, Sarah, primary, Mander, Bryony, additional, Djurdjev, Ognjenka, additional, Moselle, Kenneth, additional, Portales-Casamar, Elodie, additional, Schuckel, Victoria, additional, Singer, Joel, additional, Sobolev, Boris, additional, Wong, Shirley, additional, Brasher, Penny, additional, Cherban, Erin, additional, Young, Ella, additional, Sanderson, Kelly, additional, Neuman, Maureen, additional, Moran, Kelly, additional, Enjo, Dan, additional, and McGrail, Kim, additional

Published
2018
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34. Position Statement on Population Data Science

Author

McGrail, Kim, primary, Jones, Kerina, additional, Akbari, Ashley, additional, Bennett, Tell, additional, Boyd, Andrew, additional, Carinci, Fabrizio, additional, Cui, Xinjie, additional, Denaxas, Spiros, additional, Dougall, Nadine, additional, Ford, David, additional, Kirby, Russell S, additional, Kum, Hye-Chung, additional, Moorin, Rachael, additional, Moran, Ros, additional, O'Keefe, Christine, additional, Preen, David, additional, Quan, Hude, additional, Sanmartin, Claudia, additional, Schull, Michael, additional, Smith, Mark, additional, Williams, Christine, additional, Williamson, Tyler, additional, Wyper, Grant, additional, and Kotelchuck, Milton, additional

Published
2018
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42. Quality indicators of end-of-life cancer care: What rate is right?

Author

Barbera, Lisa Catherine, primary, Sutradhar, Rinku, additional, Burge, Fred, additional, McGrail, Kim, additional, Fassbender, Konrad, additional, Lawson, Beverley, additional, Pataky, Reka, additional, Potapov, Alex, additional, Peacock, Stuart, additional, Chu, Anna, additional, Liu, Ying, additional, and Seow, Hsien, additional

Published
2014
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